This proposed research demonstration project will attempt to reduce medical adverse events in 80 acute care hospitals in Utah and Missouri by examining existing hospital discharge data reporting systems, producing quarterly reports on adverse events for hospitals, and by conducting regulatory licensure intervention in Missouri and educational intervention in Utah. Utah and Missouri's health departments have statutory authority to collect electronic individual discharge records from all licensed healthcare facilities and to disseminate analytical results to the facilities and the public in these two states. The states use the administrative data to monitor population morbidity and healthcare issues such as access, quality, and cost. This study proposes to expand the use of the hospital discharge data system to include patient safety improvement. New classifications of ICD-9-CM N-codes and E-codes on adverse events and complications of care will be used to analyze the available hospital discharge data. Hospital medical chart reviews will be conducted to validate the reported discharge records and provide statewide estimates of adverse events and preventable errors. Structured interviews and hospital management processes surveys will be conducted. The results from these qualitative and quantitative researches will be applied in the proposed interventions. The project's success will be evaluated by two measures: process changes of patient safety practice in hospital and rates (outcome) of adverse events and complications of care in a state. These two measures will be collected through a preand post-intervention hospital survey (process) and a pre- and post-intervention medical chart review (outcome). Rural hospitals will be oversampled. Currently 42 states have hospital discharge data systems in place. This study's findings and recommendations will provide valuable information and lessons learned from other states to assist hospitals with developing a public health information system on patient safety.